Groin injuries are a common occurrence in elite-level athletes. These injuries can cause significant pain and disability, leading to prolonged periods of inactivity and consternation among athletes, coaches, athletic trainers, and physicians alike. The differential diagnosis for groin pain is vast and spans multiple disciplines, including orthopaedics, general surgery, urology, gynecology, and neurology. Sports hernias are one cause of chronic groin pain in athletes and are distinct entities from classic hernias. They are often caused by a deficient posterior wall of the inguinal canal, but may also involve concurrent injuries, such as conjoint and adductor tendinopathies and nerve entrapment. Understanding the complex lower abdominal, pelvic, and hip anatomy and pathophysiology of sports hernias is crucial to making an accurate diagnosis and providing appropriate treatment options. Newer, less invasive surgical repair techniques show promising early results in improving pain and decreasing recovery time.